Impact of Helicobacter pylori eradication on heartburn in patients with gastric or duodenal ulcer disease — results from a randomized trial programme

Abstract

Summary Background : Helicobacter pylori infection has been proposed as a protective factor against the development of gastro‐oesophageal reflux disease. Aim : To study heartburn and endoscopic findings before and after H. pylori eradication therapy in patients with peptic ulcer disease. Methods : In a multicentre trial programme, patients (n = 1497) were randomized to the omeprazole triple therapy group or to the control group, and were followed for 1–6 months after treatment. Patients in whom the infection was eradicated were compared with those in whom infection persisted. The severity of heartburn was measured at baseline and at each return visit. Endoscopy was performed 6 months after therapy in two of the five studies. Results : In patients with duodenal ulcer, there was a significantly lower prevalence of heartburn after successful eradication of H. pylori relative to that after failed eradication (estimated odds ratio, 0.48). The reduction in the prevalence of heartburn in patients with gastric ulcer was independent of the post‐treatment H. pylori status. In studies in which ulcer relapse was included in the model, this factor emerged as a significant factor for heartburn. The observed incidence of oesophagitis at the last visit was not influenced by H. pylori status. Conclusions : Eradication of H. pylori in patients with peptic ulcer disease was associated with a reduced prevalence of heartburn. Prevention of ulcer relapse could be the true cause of this reduction.

Helicobacter pylori Infection in Patients with Erosive Esophagitis Is Associated with Rapid Heartburn Relief and Lack of Relapse After Treatment with Pantoprazole

“…The effect of eradication therapy on the development of de novo esophagitis has also been studied, and an increased incidence of esophagitis in patients treated for gastroduodenal ulcer was found (24)(25)(26). In contrast, just the opposite has been reported in recent studies (27,28), which questions the effect of eradication therapy on the development of gastro-esophageal reflux.…”

Optimizing Symptom Relief and Preventing Complications in Adults with Gastro-Oesophageal Reflux Disease

“…Other recent clinical studies have demonstrated that H. pylori eradication does not exacerbate reflux symptoms [11]and nor does it increase the incidence of oesophagitis in patients with gastro-duodenal ulcer disease [12]. Thus, it seems that any risk of H. pylori eradication increasing reflux oesophagitis rates has been exaggerated in the recent medical literature.…”

There is no difference in the disease severity of gastro‐oesophageal reflux disease between patients infected and not infected with Helicobacter pylori

“…6 Although not the same population, the present results would lead to an opposite conclusion. Given that the previous report was a retrospective analysis, and given the findings of more recent prospective studies in duodenal ulcer patients, 11,14 as well as a post hoc analysis of eight studies 12 which did not…”

“…[6][7][8] Other studies have however failed to demonstrate an increase in GERD with H. pylori eradication. [9][10][11][12] Furthermore, some studies assessing the effect of eradication in GERD have shown improvement 13,14 or no change 15 in GERD. Recently, a well-designed study did not demonstrate any increase in the relapse rate of moderate to severe GERD symptoms in GERD patients post-H. pylori eradication, 16 although the investigators did not perform 24 h pH-metry.…”